Healthcare Provider Details

I. General information

NPI: 1669088308
Provider Name (Legal Business Name): DEBRA MARIE HOTALING R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 11/27/2023
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 19TH ST
WATERVLIET NY
12189-2099
US

IV. Provider business mailing address

601 19TH ST
WATERVLIET NY
12189-2099
US

V. Phone/Fax

Practice location:
  • Phone: 518-641-4920
  • Fax:
Mailing address:
  • Phone: 518-641-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number037625
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: